Leaders’ Failure to Resolve Cardiology Department Challenges at the Richard L. Roudebush VA Medical Center in Indianapolis, Indiana

The VA Office of Inspector General (OIG) conducted an inspection to evaluate leaders’ responses to long-standing Cardiology Department staffing and workplace challenges at the Richard L. Roudebush VA Medical Center (facility) in Indianapolis, Indiana. Cardiology Department challenges identified during previous OIG, Office of the Medical Inspector, and National Cardiology Program Office (NCPO) reviews remained unresolved. Although NCPO gave clear recommendations regarding actions and resources needed for the Cardiology Department, facility leaders’ responses were neither timely nor commensurate and failed to resolve underlying issues. Facility leaders failed to maintain adequate cardiologist staffing levels resulting in the reduction and suspension of cardiac procedures, which affected the retention of nurse practitioners and cardiology nursing staff, and impacted workplace stability and morale. Resources necessary for the chief of cardiology to develop the Cardiology Department were not provided by facility leaders. The chief of cardiology was not afforded protected administrative time, did not receive position-specific training, mentorship, or dedicated administrative staff. Facility leaders failed to restore the partnership with the university affiliate. Despite NCPO directing accountability for this recommendation to higher levels of leadership, facility leaders diverted accountability, placing blame on the chief of cardiology’s inability to restore the relationship. A lack of commitment to and accountability for the Cardiology Department’s challenges by facility leaders, compounded by a lack of stability within key leadership positions, undermined efforts to resolve the department’s deficiencies. In February 2022, the chief of medicine initiated targeted efforts towards supporting and stabilizing the Cardiology Department. Leaders have made modest progress in increasing the number of cardiologists and partnering with the university affiliate; however, given the department’s history and inability to sustain periodic improvements, the OIG remains concerned about continued and future stability. The OIG made two recommendations to the Veterans Integrated Service Network Director and two recommendations to the Facility Director.